MEDICARE: MS. AMANDA NICOLE HANSON NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R875468	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	385845YSCQ	OTHER	MS	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619214541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA NICOLE HANSON NP-C

Provider Business Mailing Address
First Line	:	6510 HIGHWAY 90 STE A
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5015
Country	:	US
Telephone Number	:	228-822-6148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HIGHWAY 90 STE A
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5015
Country	:	US
Telephone Number	:	228-822-6148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	04/24/2023

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